Toward a patient-based paradigm for blood transfusion

Farrugia, Albert; Vamvakas, Eleftherios C.

doi:10.2147/jbm.s55769

Cited by 8 publications

(6 citation statements)

References 73 publications

(77 reference statements)

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“…For example, in Kenya at the Kijabe Hospital, group O, nonleukoreduced CWB, stored at 4°C for up to 35 days, is commonly provided to patients (J. Kibuchi and S. Letchford, oral communication, August 15, 2015). The use of WB in developing nations has historically been limited primarily due to the lack of systems or capacity to produce components; however, some areas have resisted the adoption of component therapy for multiple other reasons …”

Section: Wb Availabilitymentioning

confidence: 99%

Whole blood for hemostatic resuscitation of major bleeding

et al. 2016

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Recent combat experience reignited interest in transfusing whole blood (WB) for patients with lifethreatening bleeding. US Army data indicate that WB transfusion is associated with improved or comparable survival compared to resuscitation with blood components. These data complement randomized controlled trials that indicate that platelet (PLT)-containing blood products stored at 48C have superior hemostatic function, based on reduced bleeding and improved functional measures of hemostasis, compared to PLT-containing blood products at 228C.WB is rarely available in civilian hospitals and as a result is rarely transfused for patients with hemorrhagic shock. Recent developments suggest that impediments to WB availability can be overcome, specifically the misconceptions that WB must be ABO specific, that WB cannot be leukoreduced and maintain PLTs, and finally that cold storage causes loss of PLT function. Data indicate that the use of low anti-A and anti-B titer group O WB is safe as a universal donor, WB can be leukoreduced with PLT-sparing filters, and WB stored at 48C retains PLT function during 15 days of storage. The understanding that these perceived barriers are not insurmountable will improve the availability of WB and facilitate its use. In addition, there are logistic and economic advantages of WB-based resuscitation compared to component therapy for hemorrhagic shock. The use of low-titer group O WB stored for up to 15 days at 48C merits further study to compare its efficacy and safety with current resuscitation approaches for all patients with life-threatening bleeding. hemorrhagic shock and immediately life-threatening injuries. DCR has many components all of which are aimed at preventing or treating shock and coagulopathy and thereby reducing morbidity and mortality from severe traumatic injuries causing massive hemorrhage.1 Hemostatic resuscitation is the central tenet of DCR. This concept developed with the recognition that a blood-based transfusion strategy would be optimal for severe bleeding and that crystalloid or colloid-based resuscitation cause hemodilution, acidosis, and a steady decline in oxygen delivery, which aggravate the underlying coagulation and metabolic disorders that evolve after injury and blood loss.2 Although a natural and obvious hemostatic resuscitation product would be whole blood (WB), it is not commonly available in the developed world, so many substitute components transfused at high ratios of plasma and platelets (PLTs) to red blood cells (RBCs) that range between 1:1:2 and 1:1:1 units, respectively. Goal-directed hemostatic resuscitation is also being explored as a method to alter empiric ratios of blood products and provide specific therapies based on the rapid results from point-of-care coagulation and shock monitoring. Recognizing the lack of robust clinical trial data available to support the development of optimal resuscitative strategies in patients with traumatic hemorrhagic shock, the following will review the history of trauma resuscitation and the evidence r...

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Section: Wb Availabilitymentioning

confidence: 99%

Whole blood for hemostatic resuscitation of major bleeding

et al. 2016

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“…The primary blood product that is currently the safest and has the least side effects is WFWB. 28 , 39 – 41 If complete component therapy is not available or does not adequately correct coagulopathy in patients with life-threatening hemorrhage at risk for massive transfusion, the risk–benefit ratio favors the use of WFWB transfusion. In addition, recent evidence suggests that WFWB is potentially more efficacious than stored component therapy.…”

Section: Warm Fresh Whole-blood (Wfwb) Transfusionmentioning

confidence: 99%

Massive hemorrhage management – a best evidence topic report

Vymazal¹

2015

TCRM

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IntroductionMassive hemorrhage remains a major cause of potentially preventable deaths. Better control of bleeding could improve survival rates by 10%–20%. Transfusion intervention concepts have been formulated in order to minimize acute traumatic coagulopathy. These interventions still have not been standardized and vary among medical centers.Materials and MethodsBased on a literature search using free term keywords and Medical Subject Heading (MeSH) index, we analyzed published articles addressing massive hemorrhage, component therapy, fresh whole blood, and fibrinogen from the year 2000 onward, in journals with impact factor >1.000, in Medline, PubMed, and Google Scholar. The evidence was grouped into topics including laboratory testing and transfusion interventions/viscoelastic assays vs standard laboratory tests, the effect of component therapy on patient outcome, the effect of warm fresh whole blood on patient outcome, and the effects of fibrinogen in severe bleeding. The obtained information was compared, evaluated, confronted, and was focused on to present an adequate and individual-based massive hemorrhage management approach.ResultsViscoelastic whole-blood assays are superior to standard coagulation blood tests for the identification of coagulopathy and for guiding decisions on appropriate therapy in patients with severe bleeding. Replacement of plasma, red blood cells, platelets, and fibrinogen in a ratio of 1:1:1:1 has appeared to be the best substitution for lost whole blood. There is no evidence that cryoprecipitate improves the outcome of patients with severe hemorrhage. Current literature promotes the transfusion of warm fresh whole blood, which seems to be superior to the component therapy in certain clinical situations. Some authors recommend that fibrinogen and other coagulation factors be administered according to the viscoelastic attributes of the blood clot.ConclusionThis best-evidence topic report brings comprehensive information about massive hemorrhage management.

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“…Treatment of combat-wounded victims at the 31st Combat Support Hospital (31st CSH) in Baghdad between 2004–2005 revealed that there were some advantages to using fresh whole blood at 20-24°C; military doctors proposed that whole blood should be used under extreme conditions with low temperatures. Farrugia et al [ 25 ] propose that in large-volume hemorrhage, fresh whole blood in may be superior to whole blood that has been reconstituted from multiple individual components. Nevertheless, research conducted by the United States Army revealed that between March 2003 and July 2007, over 6,000 units of warm fresh whole blood were used for transfusion in field hospitals of Afghanistan and Iraq.…”

Section: The Treatment Of Hypothermia In Cold Environmentsmentioning

confidence: 99%

Research progress on combat trauma treatment in cold regions

Wang

Han

2014

Military Med Res

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Cold regions are a special combat environment in which low temperatures have a great impact on human metabolism and other vital functions, including the nervous, motion, cardiovascular, circulatory, respiratory, and urinary systems; consequently, low temperatures often aggravate existing trauma, leading to high mortality rates if rapid and appropriate treatment is not provided. Hypothermia is an independent risk factor of fatality following combat trauma; therefore, proactive preventative measures are needed to reduce the rate of mortality. After summarizing the basic research on battlefield environments and progress in the prevention and treatment of trauma, this article concludes that current treatment and prevention measures for combat trauma in cold regions are inadequate. Future molecular biology studies are needed to elucidate the mechanisms and relevant cell factors underlying bodily injury caused by cold environment, a research goal will also allow further exploration of corresponding treatments.

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Toward a patient-based paradigm for blood transfusion

Cited by 8 publications

References 73 publications

Whole blood for hemostatic resuscitation of major bleeding

Whole blood for hemostatic resuscitation of major bleeding

Massive hemorrhage management – a best evidence topic report

Research progress on combat trauma treatment in cold regions

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Toward a patient-based paradigm for blood transfusion

Cited by 8 publications

References 73 publications

Whole blood for hemostatic resuscitation of major bleeding

Whole blood for hemostatic resuscitation of major bleeding

Massive hemorrhage management &ndash; a best evidence topic report

Research progress on combat trauma treatment in cold regions

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Massive hemorrhage management – a best evidence topic report